论文部分内容阅读
目的：对比不同术式对肝内胆管结石的临床疗效及安全性情况。方法回顾性分析246例肝内胆管结石患者的临床资料。按术式不同将其分为四组：A 组（胆总管切开+胆道探查+ T 管引流，简称为 T 管引流组）41例，B 组（空肠胆管吻合术组）40例，C 组（肝叶切除+ T 管引流术组）93例，D 组（肝叶切除+空肠胆管吻合术组）72例。对比四组并发症发生率、残石率及远期疗效。结果 A 组及 B 组并发症发生率分别为2.43%、5.00%，均明显低于 C 组及D 组（18.28%、19.44%，P <0.05）。C 组及 D 组残石率分别为10.75%、9.72%，均明显低于 A 组及 B 组（29.27%、27.50%，P <0.05）。非肝切除术组（A 组及 B 组）结石复发率为24.69%，明显高于肝部分切除术组（ C 组及 D 组）结石复发率（6.67%，P <0.05）。A 组及 B 组结石复发率分别为29.27%、27.50%，均明显高于 C 组及 D 组（10.75%、9.72%，P <0.05）。结论采用肝部分切除术治疗肝内胆管结石具有残石率低、结石复发率低、胆管癌发生率低等优点。“,”Objective To compare the curative effect and security of the diffrent operative methods of intrahepatic bile duct stones. Methods To retrospectively analyze the clinical data of 246 patients with intrahepatic bile duct stones. According to the operation methods,it can be divided into four groups,group A(common bile duct incision,bile duct exploration and T tube drainage,referred to as the T tube drainage),41 cases;group B(jejunum anastomosis bile duct),40 cases;group C(lobe re-section + T tube drainage),93 cases;group D(lobe resection + jejunum anastomosis of bile duct),72 cases. The incidence of complication,residual stone rate and the forward curative effect of the four groups were compared. Results The incidence of complications in group A and group B were 2. 43% ,5. 00% ,which were significantly lower than those of group C and group D (18. 28% ,19. 44% ,P < 0. 05). The residual stone rates of group C and group D were 10. 75% ,9. 72% ,which were signifi-cantly lower than those of group A and group B(29. 27% ,27. 50% ,P < 0. 05). The rate of recurrent calculi hepatic reserved group(group A and group B)was 24. 69% ,which was obviously higher than that of partial liver resection group(group C and group D)(6. 67% ,P < 0. 05). The calculi recurrence rates of group A and group B were 29. 27% ,27. 50% ,which were sig-nificantly higher than those of group C and group D(10. 75% ,9. 72% ,P < 0. 05). Conclusion Partial liver resection in the treatment of intrahepatic bile duct stones has low residual stone rate,low calculi recurrence rate,and low incidence of cholangio-carcinoma.